ORIGINAL RESEARCH
AFFILIATIONS
1Marmara University School
of Pharmacy, Department of Pharmacology, Istanbul, Turkey
2Marmara University School
of Medicine, Departments of Pharmacology and Clinical Pharmacology, Istanbul, Turkey
3Marmara University School
of Medicine, Department of Public Health, Istanbul, Turkey
Sule Oktay; Emeritus Present adress: KAPPA Consultancy Training Research Ltd, Istanbul Sena Sezen;
Present address: Johns Hopkins Medical Institutions, Baltimore, USA
Meral Keyer Uysal; Emeritus.
CORRESPONDENCE Hale Zerrin Toklu, PhD. E-mail: haletoklu@yahoo.com Received: December 16, 2009 Revision: December 23, 2009 Accepted: December 23, 2009 INTRODUCTION
In the last century the pharmacy profession con-sisted of compounding and dispensing medi-cines. As the compounding functions were sig-nificantly reduced in the last decade, the new role of the profession needed to be developed (1). The role of the today’s pharmacists needs to be ex-panded to include pharmaceutical care concepts, making the pharmacist into a healthcare profes-sional rather than a shopkeeper in a commercial enterprise (2). The mission of a pharmacy prac-tice is to provide medications and other health care products and services and to help people and society to make the best use of them (3, 4). Effective therapy with prescribed medicines re-quires a collaborative process that includes phy-sicians and pharmacists. Possible errors about the medication can be detected and reduced by pharmacists’ interventions (5-10). The pharma-cist is often the last member of the health care
team to see the patient, before the patient starts using the drug. Additionally, pharmacists are ac-cessible to patients, often seeing them on several occasions between routine physician visits. Therefore, it is the pharmacist’s responsibility to ensure the safe and appropriate use of the medi-cation by the patient (11-14).
The prescription order is a part of the profession-al relationship between the prescriber, the phar-macist and the patient (15). Correct prescribing does not guarantee that the drugs are used prop-erly. Reasons for non-adherence may be inade-quate drug information, inadeinade-quate labelling, lack of money, and cultural perceptions about drugs (16). Information is as important as the ap-propriateness of the medicines themselves. The pharmacist must provide the necessary informa-tion and guidance to assure the patient’s compli-ance in taking the medication properly (15). ABSTRACT: Good pharmacy practice in community pharmacies (CP) is essential in promot-ing the rational use of drugs (RUD). The aim of this study was to evaluate the quality of pharmacy practice in CP according to RUD principles. The following data were a part of an interventional study in which 84 community pharmacists in the Umraniye district of Istanbul were evaluated by face to face interviews and an unannounced simulated case scenario in 2002. The average dispensing time, dispensing practice, and adequate labelling were evalu-ated as rationality indicators. Our results showed that 32% of the pharmacists were not present in their pharmacies during the simulation studies. Only 40.5% of the prescriptions were dispensed by the pharmacists. Forty four percent of the pharmacy employees had no more than a primary school degree. Half of the patients applying to a pharmacy had no pre-scription. The average dispensing time for a single drug was 149 seconds in simulated cas-es although the pharmacists declared 287 seconds in the qucas-estionnaircas-es. All pharmacists reported that they explained to the patients how to administer their drugs but only 43% of the prescriptions were adequately labelled and only 6.5% included a verbal warning by the dis-pensers of possible interactions. In conclusion, good pharmacy practice was poorly applied
in CP in the selected district of Istanbul. Since most patients consulted a pharmacist for their medication (with or without a prescription), it seemed that continuing education would be essential for pharmacists and pharmacy employees in promoting RUD.
KEYWORDS: Rational use of drug, Pharmacy practice, Community pharmacist, Prescription, Dispensing time, Dispensing score.
Hale Z. Toklu
1, Ahmet Akici
2, ûule Oktay
2, Sanda Cali
3, Sena F. Sezen
1, Meral Keyer-Uysal
1The pharmacy practice of community
Providing healthcare should now include provision of appro-priate information, explanation and emotional understanding of the patients (17). More effective, fact-based information on drugs could possibly bring a more positive attitude towards drugs, leading to better compliance (18). The responsibility for noncompliance should be directed at the physician and/or pharmacist if they fail to give the patient adequate instructions or present them in a manner he does not understand (19). Irrational use of drugs is a common problem in many coun-tries, especially in developing countries (20), since in many developing countries community pharmacies are the main source of drugs. Rational use of drugs (RUD) requires that pa-tients receive medications appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time and at the lowest cost to them and their com-munity (21). Since pharmacists are an important part of the integrative health system, their role should be emphasised in promoting rational use of drugs (14). In many countries the pharmacist has a changing role as patient counsellor/educator and as an intermediary to affect patient outcomes in ambula-tory settings. Thus, pharmacists have an important role in the safe and effective use of pharmaceuticals by providing suffi-cient and accurate information to patients and monitoring the drug therapy. Good pharmacy practice in community phar-macies is essential for a proper dispensing process thereby promoting a rational use of drugs (22, 23).
Formally, the dispenser is a person who has had a special training in the art of preparing and giving medicines. In many countries (especially developing countries) dispensers with-out a formal pharmaceutical training exist. An effective dis-penser needs besides marketing skills, knowledge about drugs and the ability to communicate and consult with public and other health care professionals (23).
Although the dispensing process seems to be a simple one, it should be noted that proper dispensing takes time. The quality of dispensing increases with the time spent. The dispensing
behaviour is influenced by many factors, i.e. training and knowledge, professional compensation, lack of communica-tion skills, dispenser-prescriber relacommunica-tionships, social status of a dispenser in the healthcare system, public versus private sec-tor, promotional and marketing techniques and availability of supply (14).
In addition to the information provided, the quality of infor-mation is also important. The inforinfor-mation must be scientifi-cally accurate, unbiased and up-to-date. One FDA study in 2001 showed that although most patients received prescrip-tion drug informaprescrip-tion, the quality of informaprescrip-tion needed im-provement (24).
Community pharmacies in Turkey are private enterprises and are required by law to be managed and owned by pharma-cists. Turkish law allows a pharmacist to own and/or run only a single pharmacy. All owners and managers must be regis-tered with the regional Board of Pharmacists. All the regional boards fall under the guidance of the Turkish Pharmacists As-sociation [TEB]. Pharmacists are required to be present in their pharmacies during opening hours, but this is not strictly ad-hered to. The dispensers are either pharmacists or pharmacy employees. There are numerous untrained employees dispens-ing without the required supervision.
The aim of the present study was to evaluate the dispensing habits of the community pharmacists in one region of Istanbul from the perspective of RUD.
METHODS
The following study involves a part of the data of an interven-tional study in which 84 community pharmacists in the Um-raniye district of Istanbul were evaluated by a face to face questionnaire and a simulated case scenario in 2002.
Study population:
The questionnaire was conducted with 84 community phar-macists (total number of pharmacies in the district was 104) who had consented to participate in the study. However, 4 of them could not be reached after the third visit and 9 of them dropped after a few questions and 71 pharmacists completed the questionnaire.
Questionnaire: The questionnaire consisted of 30 structured
questions which were prepared to determine the sociodemo-graphic characteristics of the pharmacists and pharmacy em-ployees and the dispensing habits of the pharmacists. The
TABLE 1. Calculation of the total dispensing score (Maximum score = 16) Verbal information
(1 point for each, 12 points total)
• Drug’s name
• Pharmaceutical dosage form of the drug • Dosing of the drug
• Purpose of the drug • Instructions about medication • Duration of medication • Drug interactions • Food interactions • Possible side effects • Contraindications • Storage conditions • Importance of compliance Written information
(1 point) No/ wrong/ inadequate written information: 0Adequate written information: 1 Information after the
interaction question (2 points total, 1 point for dairy products and 1 point for antacids)
No/ wrong information: 0 Correct information: 2
proper dispensing and
availability (1 point) • The prescribed drug or its equivalent was given after informing the patient: 1 • Another unequivalent drug was given without
informing the patient: 0
TABLE 2. The reported daily number of applications to a pharmacy by the prescription status Daily Number of applications Prescription status With a
prescription % prescriptionWithout a % Total
0-10 40 51.3 38 48.7 78 11-20 24 49.0 25 51.0 49 21-30 10 47.6 11 52.4 21 31-40 4 66.7 2 33.3 6 > 40 2 33.3 4 66.7 6 Total 80 49.6 80 50.4 160
structured statements were strongly agree, agree, no idea, dis-agree and strongly disdis-agree.
Simulated Case Scenario: A 25 year-old patient enters the phar-macy with a constant prescription of a tetracycline capsule (Tet-ralet®) twice a day. Before leaving the pharmacy, (s)he asks the dis-penser, if (s)he could take this antibiotic with an antacid or milk, be-cause (s)he has gastritis.
The simulated patients (undergraduate students of Marmara University School of Pharmacy) visited the pharmacies two days after the questionnaire. After leaving the pharmacy, they filled out a form about the dispensing behaviours of the dis-pensers (pharmacist or pharmacy employee), who had evalu-ated their prescription.
Rationality indicators
The rationality indicators evaluated in the study were average dispensing time, stock availability and adequate labelling of the drug. The average dispensing time (starts with entering the pharmacy and ends with leaving the pharmacy) was re-corded by the use of stopwatches. The data in the question-naire and practice results of the simulated scenario were matched for each pharmacy.
Average dispensing score
An average dispensing score was calculated for each dispens-er. The maximum dispensing score was 16 for the dispensed drug. The dispensing score was based on the given verbal and written information (Table 1).
Statistical Analysis: The data were subjected to frequency
analysis by the Statistical Package for Social Sciences® (SPSS)
software version 11.0 for windows. A frequency analysis and Student’s t test were performed for the statistical analysis. The level of statistical significance was accepted as p<0.05.
RESULTS
Questionnaire
The questionnaire was conducted with 80 community phar-macists, (total number of pharmacies in the district was 104) who participated in the study. However, 9 of them dropped after a few questions and 71 pharmacists completed the ques-tionnaire. The overall response rate was 76.9% (80/104). The majority of the community pharmacists were female (79.2%) and middle-aged. The average age for all pharmacists was 38.8 ± 10.6. The average years since graduation was 15.5 ± 9.1 and the experience as a community pharmacist was 11.1 ± 9.0 years.
12.7% had a post-graduate education and 41.8% had another professional experience in a drug company or a hospital phar-macy.
All the pharmacists stated that they used a computer for online connection to the web-sites of social insurance organisations for reimbursement applications of the prescriptions. There was at least one non-pharmacist employee working in 87.5% of the pharmacies. The average number of employees was 2 per pharmacy. Almost half (44.5 %) of the pharmacy employ-ees had a primary school degree and 90.5 % of the pharmacists believed their employees were satisfactory in dispensing drugs on their own.
The pharmacists stated that the proportion of the patients who had a prescription was similar to the patients applying with-out a prescription. Most of the pharmacists said that they served up to 30 patients with/without prescription per day. The reported number of patients applying at a pharmacy in a day is shown in Table 2.
The statements of pharmacists about the items they checked on a prescription are shown in Table 3. All the pharmacists claimed to have checked the instructions about dosing and medication dosage. 97.2% of pharmacists checked the duration of medication and 90.1% checked the pharmaceutical dosage forms. The diagnosis and date of prescription were checked by 81.7 and 88.7% respectively. The name and age of the patient seemed to be checked less frequently (64.7 and 69.0% respec-tively).
Table 4 shows the type of problems pharmacists reported that they had to face on a prescription. The three most common problems were illegible prescriptions (83.1%), unavailable drugs (73.3%), and inadequate instructions about the medica-tion (56.4%) (Table 4). The other problems included: being un-able to persuade the patient or doctor about an equivalent drug, high cost of the drugs, prescriptions being written by brand-name/lack of the generic drugs in the prescriptions. Pharmacists reported that in the case of a prescription prob-lem, their approach was to call the doctor (95.8%), ask a col-league (43.7%), use their own knowledge/ judgement (93.0%), check a reference book or drug index etc (21.1%), (Table 5). All the pharmacists reported that they informed the patients about the diagnosis, the dosing of the drugs and the instruc-tions for administering the drug (Table 6). Other information
TABLE 3. Statements of pharmacists about the points they check in a pre-scription
Points checked in a prescription
(n=71) Agree (%) Unsure/ no Idea (%) Disagree(%)
Patient’s name 64.7 8.5 26.8
Patient’s age 69.0 8.5 22.5
Diagnosis 81.7 5.6 12.7
Date of the prescription 88.7 2.8 8.5
Dosing of the drugs 100.0 0.0 0.0
Pharmaceutical dosage form of the drug 90.1 1.4 8.5
Instructions about medication 100.0 0.0 0.0
Duration of the medication 97.2 1.4 1.4
TABLE 4. Statements of pharmacists about the problems they face on a prescription
The problems faced in a prescription
(n=71) Agree (%) Unsure/ no idea (%) Disagree(%)
Dosing error 53.5 4.2 42.3
Inadequate instructions about medication 56.4 5.6 38.0 Pharmaceutical dosage form error 42.3 7.0 50.7
Unavailable drug 73.3 7.0 19.7
Illegible prescriptions 83.1 7.0 9.9
Drug interactions 36.6 9.9 53.5
Contraindication 33.8 9.9 56.3
given was the duration of medication (95.8%), equivalent drugs (91.6%), storage conditions (91.6%), food interactions (78.9%), diagnosis (77.4%), compliance (76.0%), possible side effects (74.6%) and drug interactions (66.2%).
Sixty nine percent of pharmacists believed that the patients do clearly understood the information they were given. Half of them confirmed and clarified the understanding of the patients (Table 7).
According to their statements 74.6% of pharmacists were un-satisfied with their profession. Only a small percent (15.5%) was satisfied, while 9.9% had no idea/were unsure about this.
The results of the simulated case scenario
Sixty seven point nine percent of the pharmacists were present in their pharmacies at the time of the study and 90.4% stated that they spent more than 6 hours a day in their pharmacies. 40.5 % of the prescriptions were dispensed by the pharmacists. The availability of the prescribed drug, another rationality in-dicator, was 81.0% for our study. The prescription given by the simulated patients was dispensed in 93.0 % (n=78) of the 84 pharmacies whereas six dispensers (7.0%) refused the pre-scription because the drug was not available. In other pharma-cies, the prescribed drug was replaced by an equivalent after informing the patient (5.0%) or without informing the patient (6.0%). Overall, 92.0% of the patients had access to the pre-scribed drug or its equivalent. In one pharmacy (1.0%) tetracy-cline capsules were unavailable and it was replaced by doxy-cycline capsules.
The declared average dispensing time (287 ± 241 seconds) for a prescription of a single drug was almost twice the time meas-ured (149 ± 72 seconds) by the simulated patients.
Adequate labelling of the drug is another patient care indicator for RUD. The number of drug packages adequately labeled was 43.0%, whereas 10.0% were unlabeled. Moreover, 47.0% of the labeled packages were mislabeled or inadequately labeled. In spite of the pharmacists’ statements about informing the pa-tients (Table 6), it seems that their statements were only partially consistent for the instructions about medication. The informa-tion about the durainforma-tion of medicainforma-tion, drug interacinforma-tions, possi-ble side effects, contraindications and storage instructions was not given at all. The other information given was the name of the drug (20.0%), diagnosis/ purpose of the drug (8.9%), phar-maceutical dosage form of the prescribed drug (3.8%) and dos-ing of the drug (6.3%). 1.3% of the simulated patients were mis-informed about the dosing schedule (Table 8).
Some of the pharmacists claimed that they warn their patients about potential drug and food interactions (66.2 and 78.9% re-spectively) (Table 6), but only a few patients (6.5%) in the sim-ulated case scenario were warned about both interactions by the dispensers. When asked by the simulated patients, half of the dispensers (50.6%) approved that tetracycline capsule could be taken together with an antacid or milk (Table 9). The average dispensing score for the pharmacists was 3.7 ± 1.8 (n=32) while it was 2.9 ± 1.0 (n=45) for the non-pharmacist dis-pensers (p<0.01). The average dispensing score of the pharma-cists was not influenced by the factors such as sex, age or workload. On the other hand the dispensing score was found to be significantly higher for the pharmacists whose experi-ence as a community pharmacist was 5 years or less (Table 10).
DISCUSSION
Since 1990, US colleges of pharmacy and professional associa-tions (American Pharmaceutical Association, American Socie-ty of Health-System Pharmacists) have adopted pharmaceuti-cal care as the standard for pharmacy practice (25, 26). None-theless, pharmacists in general, and community pharmacists in particular, have been slow to incorporate pharmaceutical care into their daily practices (27). This expanded professional role, known as pharmaceutical care, was defined as ‘‘the re-sponsible provision of drug therapy for the purpose of achiev-ing definite outcomes that improve a patient’s quality of life’’ (28, 29).
Pharmacists are usually the last healthcare providers with whom a patient comes in contact before using a medication. (28-30). Additionally, pharmacists are accessible to patients, often seeing them on several occasions between routine physi-cian visits (31). Therefore, during the consultation with the pa-tient, the pharmacist should provide sufficient information (e.g. how to take it, how long to take it, at what times to take it, proper storage, frequently encountered side effects) to ensure the patient will safely and appropriately use the medication (12).
TABLE 5. Pharmacists’ approaches to prescription problems
Pharmacists’ approaches
(N=71) Agree (%) Unsure/noIdea (%) Disagree(%)
Calls the prescriber 95.8 1.4 2.8
Asks a colleague 43.7 4.2 52.1
Uses her/his own knowledge/judgement 93.0 1.4 5.6 Checks a reference book, drug index etc 21.1 4.2 16.9
TABLE 6. Statements of pharmacists about the information they provide to the patients about their prescriptions/ medications
Types of information given by the pharmacists to their patients about their prescriptions/ medications
N Agree
(%) Unsure/noidea (%) Disagree(%)
Diagnosis 69 77.4 4.3 18.3
Dosing of drugs 70 100.0 0.0 0.0
Instructions about medication 71 100.0 0.0 0.0 Taking drug on empty/full stomach 71 100.0 0.0 0.0
Duration of medication 71 95.8 0.0 4.2
Storage conditions 71 91.6 1.4 7.0
Possible side effects 71 74.6 8.5 16.9
Drug interactions 71 66.2 14.1 19.7
Food interactions 71 78.9 4.2 16.9
Importance of compliance 71 76.0 11.3 12.7
Rational use of drugs requires that patients receive medica-tions appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time and at the lowest cost to them and their community (21). Therefore, the aim of the present study was to evaluate the dispensing habits of the community pharmacists in one district of Istanbul from the perspective of rational drug use. The rationality indi-cators used in our study were patient care indiindi-cators (average dispensing time, adequate labelling of the drug, percentage of drugs actually dispensed) and facility indicators (qualifica-tions of the dispensers i.e. average years since education, aver-age years as a community pharmacist) (32).
According to the data obtained from the questionnaire, the majority claimed that they provide adequate verbal and writ-ten information to the patients. However the results of the simulated cases showed that the patients were poorly in-formed. Thus, the present study has demonstrated that the statements of the community pharmacists about their dispens-ing do not match with their dispensdispens-ing attitudes.
In our study almost all the pharmacists claimed that they care-fully examine the prescriptions and provide information about the medication to the patients. On the contrary, they had in-formed the simulated patients poorly. In another study con-ducted in the same district with 1618 patients, who applied to primary healthcare centres, patients were asked about the name(s) and effect(s) of the drug(s) on their prescriptions. In that study only 11% of the respondents could recall the appro-priate names of their drug(s) and 21% knew the effects of their prescribed drugs though 74% of these patients were asking for a prescription refill. Moreover, in the mentioned study 40.5% of the practitioners had informed their patients about the drug effects and 7% of these had clarified patients’ understanding (33). Taken together, it may be suggested that practitioners and pharmacists did not provide adequate information to the patients (in that region) about their prescribed drugs.
Another important point is that this is the first study calculat-ing the average dispenscalculat-ing time in Turkey. The declared aver-age dispensing time for a prescription of a single drug was approximately 5 minutes, which was almost twice the time measured by the simulated patients. The average dispensing time of 149 ± 72 seconds, found in the present study, was high-er than those previously reported in othhigh-er countries. Nevhigh-er- Never-theless, it was inadequate for a proper pharmaceutical orienta-tion, since WHO recommends that pharmacists spend at least 3 minutes in orienting each patient (34). Such inadequacy was
also reported for Brazil (53.9 seconds), Sudan (21.8 seconds), Nepal (86.1 seconds), Tanzania (77.8 seconds), Nigeria (12.5 seconds), and Bangladesh (23 seconds) (35-38). Since the pa-tients were poorly informed, we may speculate that average dispensing time should be longer so that there will be enough time for counselling.
Also, as shown in Table 1, we suggest a new method for calcu-lating the dispensing score. The average dispensing score may be a new and useful method for evaluating the quality of dis-pensing. In the present study when we have calculated the av-erage dispensing score for each dispenser, we have observed that the dispensing score of the pharmacists were significantly higher than for the non-pharmacist dispensers. In the light of this finding we may suggest that only trained health staff should provide dispensing of medicines and education of pharmacists and other health care professionals is essential for quality improvement in dispensing. Treatment guidelines and training courses should emphasise the importance of correct labelling, and giving correct and adequate information to pa-tients about their prescribed drugs (4, 39, 40).
The average dispensing score of the pharmacists was not influ-enced by factors such as sex, age or workload. On the other hand the dispensing score was found to be significantly higher for the pharmacists whose experience as a community phar-macist was 5 years or less indicating that dispensing score is closely associated with the experience. There are only few re-ports that have evaluated the criteria and factors influencing the dispensing (41-42). According to the study of Caamano et al. (2005) the dispensing practice of the pharmacists is associ-ated with their opinions on the perception of the pharmacist’s responsibility toward the rational use of drugs and their work-load (43). Thus, they have suggested that pharmacies with ex-cessive workload function in a more commercial way, reduc-ing the time a pharmacist spends with each customer and ex-erting less control over prescriptions.
The main limitation of our study is that it is not an intervention study, i.e. the dispensing behaviour should have been
re-eval-TABLE 7. Statements of pharmacists about their attitudes in providing infor-mation
Statements of pharmacists N Agree (%) Unsure/ no idea
(%)
Disagree (%)
Patients understand the information
provided 71 69.0 16.9 14.1
The pharmacists use all the opportunities to clarify patient’s understanding
71 94.4 4.2 1.4
They confirm and clarify the
understanding of the patient 71 52.1 0.0 47.9
TABLE 8. Information given by pharmacists to the simulated patients about prescriptions/ medications
Type of information given
by the pharmacist N Correctly informed ( %) Misinformed (%) Uninformed (%) Drug’s name 80 20.0 0.0 80.0 Pharmaceutical form of the drug 80 3.8 0.0 96.2
Dosing of the drug 80 6.3 1.3 92.4
Purpose of the drug 79 8.9 0.0 91.1
The instructions about
medication 78 87.2 0.0 12.8
The duration of medication 78 0.0 0.0 100.0
Drug interactions 78 0.0 0.0 100.0
Food interactions 78 2.6 0.0 97.4
Possible side effects 78 0.0 0.0 100.0
Contraindications 78 0.0 0.0 100.0
Storage conditions 78 0.0 0.0 100.0
uated after a short training course. However, it is the first study for our country to evaluate the dispensing behaviour of the community pharmacists. Moreover the calculation method we have suggested for the evaluation of the dispensing score can be a useful one.
CONCLUSION
√ Average dispensing time should be longer so that there will be enough time for counselling.
√ The dispensing score may be a useful method for the assess-ment of the quality of dispensing and intervention studies aimed at improving the quality of dispensing may be carried out using this score.
√ The dispensing scores of pharmacists are significantly high-er than those of the non pharmacist dispenshigh-ers. Thhigh-erefore,
only trained health staff should be allowed to provide dis-pensing services. Although TEB has been active in organiz-ing trainorganiz-ing programs for the non pharmacist employees in recent years, no formal training is required by law.
√ The average dispensing score of the pharmacists was not in-fluenced by factors such as sex, age or workload but is close-ly associated with experience.
√ It is essential that undergraduate and postgraduate educa-tion of pharmacists and other health care professionals aim to improve the quality of dispensing.
Acknowledgements:
The authors would like to thank Hedef-Alliance Holding A.Ş. who supported this study as well as the pharmacists who participated for their time and cooperation. The authors are also grateful to R. W. Guillery for English editing.
Conflict of Interest:
None declared.
TABLE 10. Factors influencing the dispensing score
Influencing factors Dispensing
score ± SD Statistics (Student’s t test)
Sex Male 3.71 ± 1.80 P>0.05 Female 3.71 ± 1.79 Age ≤35 3.28 ± 1.21 P>0.05 >35 3.26 ± 1.72 Experience as a community pharmacist ≤5>5 3.95 ± 1.942.90 ± 0.99 P<0.01 Workload (number of presciptions/day) ≤20>20 3.24 ± 1.423.25 ± 1.51 P>0.05
Türkiye’de serbest eczacıların eczacılık uygulamaları
ÖZET: Serbest eczanelerdeki (SE) iyi eczacılık uygulamaları akılcı ilaç kullanımı (AİK) açısından oldukça önemli bir basamağı oluşturmaktadır. Bu çalışmada serbest eczacılık uygulamalarının AİK ilkeleri açısından incelenmesi amaç-landı. Bir müdahale araştırmasının bir bölümünü oluşturan bu çalışmada, 2002 yılında İstanbul, Ümraniye’deki 84 SE’nin eczacılık uygulamaları, yüz yüze görüşme yoluyla yapılan anket ve simüle senaryo uygulaması ile değerlendi-rildi. Bir reçetenin ortalama karşılanma süresi, reçete karşılama davranışı, ilaç kutusuna gerekli işaretlemenin yapıl-ması gibi AİK parametreleri değerlendirildi. Bulgularımıza göre simüle çalışmalar sırasında eczacıların %32,0’ı ecza-nelerinde bulunmuyordu. Reçetelerin sadece %40,5’i eczacılar tarafından karşılandı. Eczacı kalfalarının % 44,5’inin eğitim düzeyi ilkokul mezunu düzeyinde idi. Eczacılar, hastalarının yaklaşık yarısının herhangi bir reçetesi olmadan eczaneye başvuran kişilerden oluştuğunu beyan etti. Reçetenin karşılanma süresini ankette eczacılar ortalama 287 saniye olarak ifade etmesine karşın, bu sürenin simüle reçete senaryolarında 149 saniye olduğu saptandı. Tüm ecza-cılar ilaçların nasıl kullanılacağı konusunda hastalarını bilgilendirdiklerini ifade ederken, simüle reçete senaryoların-da reçetelerin sadece %43,0’ının yeterli işaretlemelerinin ilaç kutusuna yapıldığı ve sadece %6,5’ine eczanede ilacı kendilerine sunan tarafından ilaçları ile ilgili etkileşimler konusunda bilgi verildiği saptandı. Sonuç olarak, iyi eczacı-lık uygulamaları açısından İstanbul’da araştırmanın yapıldığı bölgedeki SE’de yapılan eczacıeczacı-lık uygulamalarının yeter-siz olduğu görülmektedir. Reçeteli ya da reçeteyeter-siz çoğu hastanın ilaçları konusunda sıklıkla başvurduğu yerin SE’ler olduğu dikkate alındığında bu araştırmanın bulguları, eczacıların ve diğer eczane çalışanlarının sürekli eğitim kapsa-mında AİK ilkeleri doğrultusunda eğitim almalarının gerekli olduğunu ortaya koymaktadır.
ANAHTAR KELİMELER: Akılcı ilaç kullanımı, Eczacılık uygulamaları, Serbest eczacı, Reçete, Reçete karşılama süresi.
TABLE 9. The dispensers performance about the warnings to antacid and dairy product interactions with tetracycline in the case scenario
Comments of dispensers about the interactions between tetracycline and antacids/dairy products in the case scenario
n %
No comments 4 5.2
Can be taken with either antacids or dairy products 39 50.6 Can be taken with antacids but can not be taken with dairy
products 16 20.8
Can not be taken with antacids but can be taken with dairy
products 4 5.2
Can be taken with neither antacids nor dairy products 5 6.5
Can not be taken with antacids 2 2.6
Can be taken with antacids 6 7.8
Can be taken with dairy products 1 1.3
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